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IBM <br /> 111111 BIDING PERMIT APPLICAON <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT <br /> SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION: (P)425.257.8810 1(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET ."/L2 ji/k `,, 4,1 , , E PARCEL#: ei 7i0/4/%U .A <br /> CITY Lf cy STATE WA, ZIP ;'J()3 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME (if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> ( CONTACT INFORMATION <br /> � <br /> OWNER NAME: 1 C`� P 1 ��"�F, .l �t1,v1�t , l <br /> OWNER MAILING ADDRESS: STREET / ( _ , /ate(. <br /> CITY LYt1(kV j 1100 STATE CI)A ZIP e*3,S-Z)5�.y <br /> OWNER PHONE: (&�)() (il l— ,`�I/)Fs OWNER EMAIL: O bE•(-�,'�4k►�f 1i lam-) A,1-l�.,vv> <br /> CONTRACTOR COMPANY NAME: 0 it,'/l,l <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: fij OWNER CONTRACTOR JTHER(Please Specify) <br /> CONTACT NAME: ...f b „ ^ CONTACT PHONE: <br /> v ww`u CONTACT EMAIL: '] y,, <br /> p Y,, <br /> ii?rJ Li/�1�)£? CJ�f_' •Cz:VV1 <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $ C.,0100r;`- ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: Rp=� <br /> PROPOSED USE OF BUILDING: <br /> HEAT SOURCE: ;as h lectric )ther <br /> BUILDING TYPE: X ,FR Cwnhouse tuplex [ DU lulti-Family-#Units: f ommercial ,ccessory Structure <br /> TYPE OF PROJECT(check all that apply): I Iew Construction 1 ddition Elemodel ■epair r [I. :hange of Use <br /> lodular [}ortable He-roof xterior Alteration ank(above ground) F,ccessory Structure <br /> :ence over 7ft high .ackStorageTlool/Hot Tub ank(above ground) Ix)ther: <br /> DESCRIPTION OF WORK: 1rv1 g} 61 <br /> D Kvd. FgA,i etc) >: L <br /> r <br /> Aetc -Boor i V1 - We. o- i►' 0. 6 kY`c c rnrrr <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ner/Authorized Agent Signature Date (Revised 2/8/2021) <br />